Access to internal and external structures of the heart may be desirable for the treatment of cardiovascular disease. In some cases, the treatment may involve the delivery of devices to the heart. One way in which a heart may be accessed for device delivery is by an intravascular approach. Intravascular pathways to the heart may involve advancing the device from a femoral vein to the vena cava, through which the chambers and valves of the right side of the heart (e.g., right atrium, right ventricle, etc.) may be accessed. The left side of the heart may also be accessed from this approach by a transseptal procedure. Alternatively, the left atrium and left ventricle may be intravascularly accessed by a retrograde pathway from the aorta.
However, intravascular access to the heart may not be ideal in all circumstances, such as for the delivery of larger devices, or for accessing external heart structures. In these circumstances, the heart may be accessed from an epicardial surface. For example, treatment of atrial fibrillation may involve accessing and delivering devices to the left atrial appendage. Such treatments may include closing the left atrial appendage, for example, by suturing along the base or ostial neck of the appendage, where it joins the atrial chamber. Certain treatments to close the appendage may also include cinching the ostial neck, for example, using devices and methods described in U.S. patent application Ser. No. 12/055,213, filed on Mar. 25, 2008, which is hereby incorporated by reference in its entirety. While these devices and methods access external structures of the heart, other devices and methods may be provided to access internal structures of the heart from an epicardial surface.